Provider Demographics
NPI:1104207869
Name:BECK, KATHLEEN AMBER
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:AMBER
Last Name:BECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 CENTER AVE
Mailing Address - Street 2:APT.3
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-5101
Mailing Address - Country:US
Mailing Address - Phone:989-859-2924
Mailing Address - Fax:
Practice Address - Street 1:1500 CENTER AVE
Practice Address - Street 2:APT.3
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-5101
Practice Address - Country:US
Practice Address - Phone:989-859-2924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other